by David Sisler

A single light bulb, screwed into a fixture which is operated with a pull string, the fixture hanging at the end of old, brown electrical wire, casts an uneven light around the attic. A large box is in the farthest corner of the attic, dust-covered in a section that the 60-watt bulb barely reached.

The old man who had owned the house was dead, the will had been probated, and the family was clearing out his things. Most of the "treasures" had long before been discovered, but there was hope that this last chest might contain something of value.

A sheet of paper had been taped to the top of the box and in a firm hand, the old man had prepared a label: "Pieces of string too short to save." But save them he had.

The Wall Street Journal, in a story by Ron Winslow, recently chronicled the death of another man, 69-year-old retired prison guard Slim Watson (the quotations which follow are from Mr. Winslow's article).

Mr. Watson had worked in Pennsylvania for 31 years in the state's prison system and had retired to his native North Carolina. Bothered by the usual medical conditions of growing older, Mr. Watson went to the doctor because of some dark circles which had appeared on his skin. He was admitted to the hospital with anemia and internal bleeding.

At Duke Medical Center further tests revealed that he had a condition called "acquired factor VIII inhibitor. Antibodies produced by his immune system had begun attacking his factor VIII, a protein critical to blood clotting. Most hemophiliacs lack this blood factor congenitally. But each year, about 250 Americans with no previous clotting problems suddenly develop a factor VIII disorder, for reasons that are mostly a mystery." Mr. Watson was bleeding in his gastrointestinal tract. If doctors could not stop the bleeding, he would die.

An optimistic treatment started - 75 percent of patients with acquired factor VIII inhibitors are treated successfully. The first course of medicine was Hyate:C, a form of factor VIII, derived from pig blood. The wholesale cost of the drug is $1,000 per vial, but the bleeding usually stops within a few days. 15-24 vials are necessary for the initial dose and full treatment requires about 100 vials. Mr. Watson was using the medicine at the rate of $30,000 every four hours.

Mr. Watson was also given steroids, cancer drugs, blood transfusions, high-tech X-rays, nuclear scans, and dialysis-like treatments. And still the bleeding continued.

A major change in his treatment occurred when doctors decided to remove a section of Mr. Watson's colon, thought to be the most likely source of the bleeding. After surgery doctors ordered increased doses of Hyate:C, at the retail cost of more than $250,000 per day. Nine days after entering Duke, the internal bleeding seemed to stop. For the first time in more than a week, cautious optimism was the watch-word.

Six days later, the bleeding resumed.

Mr. Watson's body had developed a resistance to Hyate:C, and his doctors switched him to a genetically engineered, and much more expensive, drug, NovoSeven. "In part because of the biotech drug's complex manufacturing requirements, NovoSeven costs $6,800 wholesale for one small vial."

Almost two weeks after surgery Mr. Watson still had not regained normal bowel functions and could neither eat nor drink by mouth. His condition was deteriorating.

On his 30th day at Duke "his condition suddenly worsened. His stomach and lower body filled with blood. He became short of breath. His kidneys began to fail.

"'At that point, I think everybody agreed that we had tried everything we could,' Dr. Thomas Ortel says.

"Mr. Watson seemed to have had enough as well. 'He said he got his spiritual side together and got his soul right with God,' recalls Mrs. Watson, his wife of 46 years, tears welling. Over the next couple of days, his two daughters, his son, his two brothers and Mrs. Watson spent time with him one by one. 'We told him if he wanted to go, he could,' Mrs. Watson says.

"The blood-factor treatment was stopped, and Mr. Watson was put on sedatives to ease his discomfort. On the afternoon of Nov. 13, with several of his family members at his side, he smiled and blinked.

"'Finally, he just closed his eyes,' Mrs. Watson says."

The hospital bill for the 34 days Mr. Watson was a patient ran to 45 pages. NovoSeven cost $1.9 million, Hyate:C cost $2.9 million. The total bill was $5,214,333.50.

Pieces of string too small to be saved, but saved.

$5 million spent to save the life of a 69-year-old man with diabetes, heart problems and psoriasis, and spent without hesitation.

How small is too small to be saved?

How much is too much to spend to be saved?

Maybe the string collector would have set a lower limit. Maybe the hospital would have reached an upper limit. But the Lord God Almighty did not, could not, do either. From all eternity he planted the cross on Golgotha's Hill and said, "This is for you. You are not too small. The cost is not too great. Whosoever will, trust my Son and live forever!"


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Copyright 2001 by David Sisler. All Rights Reserved.

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